超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞对肾移植患者术后早期疼痛和恢复质量的 影响：一项回顾性研究

Efficacy of Transversus Abdominis Plane Block Combined with Rectus Sheath Block on Postoperative Pain and Quality of Recovery in Renal Transplant Patients: A Retrospective Study

摘要: 目的：探究腹横肌平面阻滞联合腹直肌鞘阻滞对肾移植患者术后早期疼痛和恢复质量的影响。方法：回顾性收集2023年9月至2025年1月于本院临床诊断为终末期肾病并接受供肾为非亲属捐赠的同种异体肾移植手术患者的病历资料。年龄18~65岁，BMI 18~30 kg/m²，根据麻醉诱导前是否行手术切口侧腹横肌平面阻滞联合腹直肌鞘阻滞分为阻滞组(R组)与对照组(N组)。记录术后1 h、6 h、12 h、24 h、48 h静息和活动时的VAS评分、术后24 h、48 h的QoR-15评分、术中阿片类药物用量、术后48 hPCIA有效按压次数、围术期补救镇痛发生率、围术期肾功能指标变化、不良反应发生率。结果：与N组相比，R组术后1 h、6 h静息时及术后1 h、6 h、12 h活动时的VAS评分降低，术后24 h、48 h的QoR-15评分提高，术中瑞芬太尼用量、术后48 h PCIA有效按压次数及苏醒后至术后48 h内补救镇痛发生率减少(P < 0.05)。两组在围术期肾功能指标变化、术后24 h不良反应发生率未见统计学意义(P > 0.05)。结论：超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞可以有效缓解肾移植患者术后早期疼痛并有利于患者术后恢复。

Abstract: Objective: To retrospectively investigate the effect of transversus abdominis plane block combined with rectus sheath block on early postoperative pain and quality of recovery in renal transplant recipients. Methods: The medical records from patients who were clinically diagnosed with end-stage renal disease and underwent allogeneic renal transplantation in which the donor kidney was an unrelated donor in our hospital from September 2023 to January 2025 were retrospectively collected. Aged 18~65 yr, with body mass index of 18~30 kg/m², they were divided into block group (group R) and control group (group N) according to whether transversus abdominis plane block combined with rectus sheath block was performed on the lateral side of the surgical incision before induction of anesthesia. Data collected included the visual analogue scale (VAS) scores at rest and during activity at 1 h, 6 h, 12 h, 24 h, and 48 h after surgery, the Quality of Recovery-15 (QoR-15) scores at 24 h and 48 h after surgery, intraoperative opioid consumption, number of effective patient-controlled intravenous analgesia (PCIA) attempts at 48 hours after surgery, incidence of perioperative rescue analgesia, perioperative changes in renal function parameters, incidence of adverse reactions were also recorded. Results: Compared with group N, group R had lower VAS scores at rest in the 1 h and 6 h postoperative period and during activity in the 1 h, 6 h and 12 h after surgery, higher QoR-15 scores in the 24 h and 48 h after surgery, decreased intraoperative remifentanil consumption, reduced the number of effective PCIA attempts and the incidence of perioperative rescue analgesia from anesthesia to 48 h after surgery (P < 0.05). The two groups showed no statistically significant differences in perioperative renal function changes, the incidence of adverse reactions at 24 h postoperatively (P > 0.05). Conclusions: Ultrasound-guided transversus abdominis plane block combined with rectus sheath block is effective in relieving early postoperative pain and facilitating postoperative recovery in renal transplant patients.